Radical prostatectomy vs minimally invasive robotic prostatectomy

Asked BARD and answered (pretty sterile answer):

A radical prostatectomy is a surgery to remove the entire prostate gland and some of the surrounding tissue. It is the most common treatment for prostate cancer.

There are two main types of radical prostatectomy: open radical prostatectomy and minimally invasive robotic prostatectomy.

Open radical prostatectomy is the traditional approach. The surgeon makes a large incision in the abdomen or perineum (the area between the scrotum and the anus). This allows the surgeon to have a clear view of the prostate gland and surrounding tissue.
Minimally invasive robotic prostatectomy uses a robotic system to perform the surgery. The surgeon makes several small incisions in the abdomen and inserts the robotic arms through these incisions. The robotic arms are equipped with tiny cameras and instruments that allow the surgeon to operate the prostate gland with more precision than is possible with open surgery.

I was also told that the dexterity of the robotic "hand" is so much better than a persons, the surgeon can do a more comprehensive job of stitching the urethra back together after the removal of the prostate. More and more even stitches as compared to doing the repair without robotic assistance.

The recovery of the abdominal area is much quicker and there is less chance of infections.

Here are a couple articles on it...
https://news.harvard.edu/gazette/story/2022/03/comparing-traditional-vs-robotic-assisted-surgery-for-prostate-cancer/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881188/
Best of luck to you!

Retired Gynecologic surgeon here. I had robotic prostatectomy last April. Reading the above references and others, the things that are significant IMO are:

1. Increased risk of blood transfusion with open. That means probably a loss of AT LEAST 20-25% of total blood volume during surgery. That would mean other issues as well, like increased risk of internal scarring, more post-op pain, slower recovery...
2. Increased risk of infection, especially in the abdominal skin incision. While not life threatening, if it happens, it is a big bother for months.
3. Increased risk of bladder neck contracture, which makes recovery of normal urinary function more difficult that it already is.
4. No question return to "normal" activity level such as exercise is faster with robotic. Also less pain in the first few weeks after surgery.

There's no evidence (yet) the "cure" rate, the return of normal bladder function and erectile function are any better with robotic.

Speaking as a surgeon, I believe a well-trained roboticist will be more careful and precise with their work than the same MD. would be using their fingers alone. Makes for a longer procedure, with decreased risk of complications.

I cannot compare. But I can say that, after my RALP on 8/23/2022, I had ZERO pain after surgery. I had some discomfort during the one night following the procedure. I may have taken some Aleve, but nothing more.

I had five incisions across my abdomen that healed normally.

I wish you the best in your choosing and in your procedure.

Hi all. I had robotic surgery on March 7th of this year. The surgery was 6.5 hours and initial recovery was difficult. It took a month before I felt somewhat like myself. Now six months post surgery I am doing great. Returned to normal exercise routine after month three. Incontinence only when I cough…and getting better. I would say in terms of ED, I’lm 50% there.

So yes I would recommend robotic surgery over alternative methods.

Bob S.

How old are you? My husband is 62 and will be doing the robotic as well. Did you do nerve sparing ?

I once had a non-laparoscopic hernia surgery. The MD who did it only did hernias, in his own facility, in Taiwan. My referring primary care MD pointed out that healing is based (in part) on how quickly the wound is opened and closed. At the major hospitals the hernias are all done by the newest surgeons, so they can get practice. This guy, on the other hand, thought he should be in the Guinness Book of World Records for most prostate surgeries.
That was an illustration of what has been found in the studies comparing open to laparoscopic to robotic laparoscopic surgeries. The main identifiable difference is how many surgeries the MD has done.
So, if your surgeon has done 1000 open prostatectomies, you want him to do it open. If he's done 700 robotic laparoscopic, you want him to do it that way. The urologist who did them open felt he could better identify what he was teasing apart--nerves and prostate. the prostate is sheathed in nerves, hence the challenge of "nerve-sparing."
But the urologist he referred me to, who trained in the same hospital (Vanderbilt) and actually practices in my city, had done 700 RALPs when he did me last year, so that's what I wanted him to do--of course.
Another factor is that RALPs are in fashion, so the younger MDs tend to do it that way. I assume this is entirely unrelated to the marketing of the hugely expensive DaVinci robot systems and the resulting higher cost of RALP vs open RP.
So I'm saying you really don't have to choose. Your choice of surgeon will determine the method. The surgeon matters more than the equipment. I hope you find a good surgeon on a good day and things go incredibly well!